title: Nurse-sensitive indicators suitable to reflect nursing care quality: a review and discussion of issues.
abstract: OBJECTIVE
  To review nurse-sensitive indicators that may be suitable to assess nursing care quality.
  
  
  BACKGROUND
  Patient safety concerns, fiscal pressures and patient expectation create a demand that healthcare providers demonstrate the quality of nursing care delivered. As a result, nurse managers are increasingly encouraged to provide evidence of nursing care quality. Nurse-sensitive indicators are being proposed as a means of meeting this need.
  
  
  METHODS
  Literature review.
  
  
  METHODS
  A review of the literature was conducted using CINAHL and MEDLINE from 2002-2011. Key search terms were nurs* and sensitive indicators, outcome measures, indicators, metrics and patient outcomes.
  
  
  RESULTS
  Most of the research has examined the relationship between nursing structural variables and patient outcomes in acute care settings and have explored potential indicators for specific patient groups and nursing roles. When using nurse-sensitive indicators, issues concerning the selection, reporting and sustained use are important for nurse managers to consider.
  
  
  CONCLUSIONS
  Evidence for the nurse-sensitivity of some commonly used indicators is inconsistent due to the disparity in definitions used, data collection and analysis methods. Further research on the application and implementation of these indicators is required to assist nurse managers in attempting to quantify the quality of nursing care. Nurses need to continue to strive to achieve agreement on the definitions of indicators, gather strong consistent evidence of nurse-sensitivity, resolve issues of regular data collection and consider selection, reporting and sustainment when implementing nurse-sensitive indicators.
  
  
  CONCLUSIONS
  Once identified, nurse-sensitive indicators can be applied for quality improvement purposes, but consensus is required to fully realise their potential. Nurse managers need to be aware of the factors that can influence the use of indicators at unit level. Strategies need to be implemented to promote these indicators becoming integrated with routine nursing care.
authors.affiliation: School of Nursing and Midwifery, Griffith University, Gold Coast, QLD, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Burston
authors.forename: Wendy
authors.initials: W
authors.lastname: Chaboyer
authors.forename: Brigid
authors.initials: B
authors.lastname: Gillespie
mesh_terms: D002983:Clinical Competence; D006801:Humans; D009726:Nurses; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D011795:Surveys and Questionnaires
keywords: nurse-sensitive indicators; nursing care quality; nursing outcome measures; quality improvement initiatives